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SZEGEDI TUDOMÁNYEGYETEM

ÁLTALÁNOS ORVOSTUDOMÁNYI

KAR

IGAZSÁGÜGYI ORVOSTANI INTÉZET

Fiatal Igazságügyi Orvosszakértők Fóruma

(FIOF)

Szeged

2016. május 26-27-28.

Absztrakt könyv

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SZERVEZŐBIZOTTSÁG

Dr. Mai Tímea

Dr. Szabó Helga

Dr. Sija Éva

Dr. Szécsi András

Dr. Pintér Katalin Marietta

ELŐADÁSOK HELYSZÍNE

Az Eko Park Szeged konferenciaterme

TÁMOGATÓINK

MIOT

Medicina Kiadó

Roche (Magyarország) Kft.

Szegedi Igazságügyi Orvosszakértői Kamara

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KÖSZÖNTŐ

Kedves Kollégák és Barátaink!

Nagy örömünkre szolgál, hogy a 2016-os évben a Fiatal

Igazságügyi Orvosok Fóruma (FIOF) Szegeden kerül

megrendezésre május 26-28.-án.

A jó társaság garantált, reményeink szerint a programok

tartalmasak és emlékezetesek lesznek. Kívánjuk, hogy

gyarapodjon a tudásotok és érezzétek jól magatokat!

A szervezők

WELCOME MESSAGE

Dear Colleagues and Friends,

It is our great pleasure to host the Meeting of Young Forensic

Pathologist (FIOF 2016) in Szeged, 26th-28th, May, 2016.

The good company is guaranteed, the program will hopefully be

exciting and interesting. We wish you to broaden your knowledge

and have a wonderful time.

The Organizing Committee

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PROGRAM

2016. május 26.

Csütörtök - Thursday

Regisztráció - Registration

Ebéd - Lunch

Megnyitó – Opening ceremony

I. szekció (magyar nyelvű)

Üléselnök/Chairman: Dr. Kereszty Éva - Dr. Kozma Mihály

Éva Kereszty: The new Act on legal experts

Ernő Fejes: Assemlage of the expert opinion

András Szécsi: Tendencies of medical investigation in death cases

occuring outside of hospital in Szeged and the region

Gábor Simon: Effects of diseases with structural liver changes on blunt-

force liver injuries

Marietta Katalin Pintér: Fatal stabbed and incised injuries

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II. szekció (magyar nyelvű)

Üléselnök/Chairman: Dr. Tóth Zsuzsanna - Dr.Csányi Bernadett

Imre Szabó: Jogakadémia

Éva Sija: The forensic importance of metabolites

Viktor Soma Poór: In vino Cocto Veritas?

Dénes Pauka: Fatal accidental carbon-monoxide intoxication following

overdose of multiple stimulants

Bernadett Csányi: Archaeogenetic analysis of the Hungarian conquest

period cemetery Karos-Eperjesszög III.

Zsuzsanna Huszta: The importance of medical imagery in the forensic

medical practice

Bográcsos vacsora, Meglepetés program – Dinner, Surprise program

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2016. május 27.

Péntek - Friday

III. szekció (angol nyelvű, English speaking)

Üléselnök/Chairman:: Prof. Dr. Varga Tibor - Dr. Weiczner Roland

Hangau B. : Hydatid cyst as an autopsy surprise. Case presentation and

literature data

Radnić B. : Case report of unusual head gunshot entrance wounds- An

exeption of rules

Cvetković D. : Giant aneurysm of basilar system ascidental autopsy

finding

Durmić T. : Iatrogenic tracheoarterial fistula: Case report and review of

lietrature

Manar Buni: Examination of Death Penalty around World

IV. szekció (angol nyelvű, English speaking)

Üléselnök/Chairman:: Dr. Kozma Zsolt - Dr. Havasi Beáta

Tamás Krompecher: The challenge of identification following the

tragedy of the Solar Temple (Cheiry/Salvan,

Switzerland)

Tímea Mai: Radiological findings versus mechanism of injury– A case

report

V. szekció (magyar nyelvű)

Üléselnök /Chairman:: Dr. Gergely Péter - Dr. Szabó Árpád

Tibor Varga: The functioning of the Body of Forensic Experts of the

Scientific Health Committee and the experiences of the

recent years

Kálmán Rácz: Heat haematoma

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Roland Weiczner: Quest for the holy grail of forensics:

immunohistochemical age estimation of injuries

Dénes Tóth: The role of forensic histopathology in routine practice

Tibor Varga: Human trafficking – Migrant victims

VI. szekció (magyar nyelvű)

Üléselnök/Chairman: Prof. Dr. Krompecher Tamás - Dr. Szabados

György

Csaba Nagy: The involvement of experts in criminal proceedings

Árpád Szabó: Gunshot wound “identification” (completing the

inappropriate medical records)

András Slezák: An agressive man’s death shortly after police

intervention

Helga Szabó: I am poisonous for you!

J. Bokor: The role of extended pathological examination in suspected

sudden infant death (SIDS) cases

Péter Gergely: Constats – or what can we do with medical documents?

Roche (Magyarország) Kft.: Roche Diagnostic solutions in Forensic

laboratories

Medicina Könyvkiadó: Könyvbemutató: Gyermekbántalmazás (szerk.:

Törő Klára-Nagy Anikó)

Grill vacsora - Dinner

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2016. május 28.

Szombat – Saturday

VII. szekció (magyar nyelvű)

Üléselnök/Chairman: Dr. Törő Klára - Dr. Molnár Attila

Gábor Kereszty: Injuries caused by bites by dogs and cats from the

aspect of the veterinary

Antal Kricskovics: Differential diagnostic problems concerning a

person, deceased in penitentiary institute: Case report

Barbara Kasza: Injuries of orofacial region in childhood

Nóra Heltai: Forensic analysis of injuries in dentistry

Csilla Dézsi: A prospective observational study of rugoscopy: A

reliable, cheap and accurate method for forensic

identification

Károly Szili: Law and ethical aspects of different obstetrics and

biochemical metods during the pregnancy

Díjak átadása - Prize giving ceremony

Zárás – Closing ceremony

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ABSTRACTS

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SESSION I.

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THE NEW ACT ON LEGAL EXPERTS

Éva M Kereszty MD, PhD

Department of Forensic Medicine, University of Szeged

The Act on legal experts, that came into effect 10 years ago, is

relayed by the Act No. 29 of 2016, i.e. the new Act on legal experts,

from 15th June, 2016. A new point in the new Act is that the rules on the

functioning of the chamber and the Act on the chamber of legal experts

are incorporated into one uniform Act. As supposed before, the chamber

becomes a uniform, national organisation and leaves behind the regional

structure. Its new task is the qualification of the legal experts. The rules

on the new organisation will come into effect on 15th September, 2016;

the rules on the new tasks will come into effect on 1st January, 2017.

As for the activity of legal experts, the new Act introduces

quite a few ethico-legal responsibilities and sanctionable omissions. It

also introduces the institution of electronic data transfer between legal

expert and ordering justice/authority. It also makes the requirements of

the register of legal experts more exact. As for the fee of the legal

experts, the right to interest becomes clear and it also introduces a new

chamber fee, which is to be requested by the legal expert in each and

every case.

The organisation of the legal experts remain unchanged. There

is no exact regulation on organisational level, on the level of

competence and on the assessment of fees, which would make the

allocation of cases and the professional reorganisation calculable.

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TENDENCIES OF MEDICAL INVESTIGATION IN

DEATH CASES OCCURING OUTSIDE OF

HOSPITAL IN SZEGED AND THE REGION

Dr. Szécsi András

ISZKI BKMI, Kecskemét Trombita u. 2.

In Hungary, about 30% of the deaths occur outside of the

hospital: at home or in public places, and 80% of these death cases there

is no autopsy needed. In the region of Szeged, the autopsies of those

who deceased at home or in public places are carried out by the staff of

Department of Forensic Medicine regardless of the fact, that the death is

considered to be natural or extraordinary according to the death-

investigator doctor.

Our Institute – as opposed to the only regular-autopsy-

established pathology departments – has proper forensic background,

which allows to the doctor performing the autopsy to do additional tests

if any extraordinary fact is detected and after report the case to the

police. The fact, - that there have been ordinated as regular autopsy. but

later reported as third persons suspected cases,- highlights the

responsibility of the doctor who performs the investigation of the

deceased and the major importance of autopsy of those who died outside

of the hospital.

In my presentation I will briefly review the rules of death-

investigation, the extraordinary or extraordinary-suspected death cases,

which have been reported to the police in the recent years in the sub-

region of Szeged and with examples taken out of the context I am trying

to convey the role of the law&regulations in specific situations and the

special place of forensic medicine in autopsy.

Keywords: death investigation, medico-legal autopsy

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EFFECTS OF DISEASES WITH STRUCTURAL LIVER

CHANGES ON BLUNT-FORCE LIVER INJURIES

Gábor Simona, Dénes Tóth

a, Viktor Soma Poór

a, Prof. F.

Tamás Molnárb

aDepartment of Forensic Medicine, Medical Faculty of Pécs University,

Pécs, Hungary bDepartment of Operational Medicine, Medical Humanities, Medical

Faculty of Pécs University, Pécs, Hungary

The effect of different liver diseases on vulnerability of the

liver tissue to blunt force injuries are often questioned and debated in

forensic situations. We present the preliminary results of an examination

of liver samples from autopsies: vulnerability to quasi-static blunt-force

of 75 liver samples were examined with a tool uniquely designed for this

research. The results show slight decrease of average vulnerability

values in steatosis and large decrease of average vulnerability values in

cirrhosis. Significant decrease in vulnerability (increased resistance to

blunt-force) was proven in case of cirrhosis and infiltrative liver

diseases.

Keywords: forensic pathology, blunt-force, liver injury

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FATAL STABBED AND INCISED INJURIES

Marietta Katalin Pintéra, Kereszty Évab

a-bDepartment of Forensic Medicine, University of Szeged

Bodily injuries are often caused by sharp or pointed instruments

in Hungary. This is probably because weapon possession and weapon

use are under rigorous legal regulation while sharp and pointed

instruments could be found in every household. In 2012 129 cases of

homicide were committed, stabbed or incised injuries caused the death

of the victim in 52 of these cases.

I reviewed autopsies performed in Csongrád county between

2003 and 2013, regarding cases, when stabbed, incised or stabbed-

incised injuries leaded to death.

I compaired my results with nationwide data and data from

other European countries with a similar number of population, regarding

both self-inflicted and violent stabbed and incised injuries.

Keywords: stabbed injuries, incised injuries

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SESSION II.

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THE FORENSIC IMPORTANCE OF METABOLITES

Éva Sija

University of Szeged, Department of Forensic Medicine, H-6724 Szeged,

Kossuth L. sgt. 40 (Hungary)

After consumption, most of drugs an narcotics are excreted

with urine in an unchanged form. In many cases, the period of detection

may be enlarged by measuring metabolites. E.g., the half-life time of

benzoylecgonine, which is one of the main metabolites of cocaine, is

markedly longer than the half-life time of the mother molecule.

Therefore, it is traceable even days after consumption. The quantitative

determination makes it possible – supposing an average doses – to

closely determine the time-point of consumption. From this aspect, the

measuring of benzodiazepines, might be misleading. 7-amino-

clonazepane (metabolite of clonazepane), which shows sawtooth-like

elimination curve is a good example.

Measuring of metabolites conjugated with glucuronide acid is generally

accomplished after hydrolysis in free form (e.g. opiates, THC-OH or

THC-COOH). In case of synthetic cannabinoids, the mother molecule,

as well as the metabolite, frequently conjugate with glucuronide acid,

thus, these are normally detected after glucuronidase enzymes cleavage

or after alkaline hydrolysis.

Since these derivates are present in humors in low concentration and it

metabolises quickly, the verification of narcotic consumption can be

really effective, when the presence of metabolites is verified.

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IN VINO COCTO VERITAS?

Viktor Soma Poóra, Mátyás Mayerb

a-bUniversity of Pécs, Faculty of Medicine, Department of Forensic

Medicine

Pécs, Szigeti u. 12, Hungary

Mulled vine is the favourite hot alcoholic drink of the winter

season. By definition mulled vine is a hot, vine based drink with added

water, sugar and spices.

Several factors can affect the alcohol content of these drinks (e.g.

the amount of added water). In our study, we wanted to compare the

alcohol content of mulled vines from various sources.

Ethyl-alcohol concentrations were determined by gas

chromatography. The average alcohol concentration (V/V%) was 6.56%

(median: 7.75%), but the alcohol content of the samples varied wildly

(minimum: 0.31%, maximum: 9.75%, standard deviation: 3.06%).

In further experiments we have shown that contrary to the

popular belief, alcohol content of mulled vines do not change

significantly during preparation.

Keywords: ethyl alcohol, gas chromatography

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FATAL ACCIDENTAL CARBON-MONOXIDE

INTOXICATION FOLLOWING OVERDOSE OF

MULTIPLE STIMULANTS

Dr. Pauka Dénesa, Dr. Tóth Dénesa, Dr. Simon Gábora

aPécsi Tudományegyetem Általános Orvostudományi Kar

Igazsgágügyi Orvostani Intézet

7624 Pécs, Szigeti út 12.

Bodies of two young males sitting in a car were found in the

morning hours in a garage. Multiple injection marks were detected

during the post-mortem examination. The police investigators found

syringes, several cigarettes, blue residual material, green plant debris,

and white-green crystal-like material in the car. The toxicological

examination proved that carbon monoxide poisoning (80 % in both

victims) was the direct cause of death, and also proved pentedrone (3767

ng/ml and 3413 ng/ml b.c.), MDMA (2173 ng/ml and 504 ng/ml b.c.),

and amphetamine (1788 ng/ml and 979 ng/ml b.c.) overdose.

Keywords: forensic sciences, autopsy, carbon-monoxide, pentedrone,

amphetamine, MDMA

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ARCHAEOGENETIC ANALYSIS OF THE

HUNGARIAN CONQUEST PERIOD CEMETERY

KAROS-EPERJESSZÖG III.

Bernadett Csányia, Éva Keresztya, Endre Neparáczkib, György

Pálfic, Tibor Törökb

aDepartment of Forensic Medicine, University of Szeged, Kossuth L. sgt.

40. bDepartment of Genetics, University of Szeged, Közép fasor 52.

cDepartment of Anthropology, University of Szeged, Közép fasor 52.

In this study 19 skeletons /11 men, 5 women and 3 children/,

derived from a well-documented 10th

century cemetery at Karos –

Eperjesszög III, were included. Burial site and bones were

archeologically and anthropomorphically well defined before analysis.

Based on serogenetic examination /ABO blood type determination/ Imre

Lengyel established the probable kinship relations between the

specimens. To clarify the genetic relationships between individuals

DNA was extracted from tooth and bone samples of the ancient remains.

The maternal lineages based on mitochondrial DNA polymorhisms, the

paternal Y-chromosomal lineages, as well as autosomal short tandem

repeats were analysed. The genetic data contradict most of the

paleoserology results.

Keywords: archaeogenetic, mitochondrial DNA, Y-chromosomal DNA,

short tandem repeats

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THE IMPORTANCE OF MEDICAL IMAGERY

IN THE FORENSIC MEDICAL PRACTICE

Zsuzsanna Huszta

Department of Forensic Medicine, University of Szeged

Introduction: In the last 100 years, radiology obtained an

increasing field in forensic medicine. Thanks to this, the time-point of

fractures became easier to diagnose; traditional dissections are helped by

virtual dissections. These instruments are of high importance before

court (violence, indemnity, etc.).

Method: I used 14287 expert’s opinions issued by the Institute of

Forensic Medicine of Szeged between 2008-2012. I focused on

radiological constats.

Results: Out of 387 cases, I chose those ones in which a specialty

consultant was involved. Out of the remaining 66 cases, I chose those

ones in which the diagnosis was changed after reconstat: 13 cases

occurred.

Discussion: The radiological imagery conveys objective data on

the clinical state, which are univoque for everyone. A certain difference

between clinical diagnosis and forensic medical diagnosis is

demonstrated by the fact that reconstat was ordered in 17,1 % of the

cases.

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SESSION III

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HYDATID CYST AS AN AUTOPSY SURPRISE.

CASE PRESENTATION AND LITERATURE DATA.

Hanganu B, Velnic A, Ioan B

Forensic Medicine, “Grigore T. Popa” University of Medicine and

Pharmacy, Iasi, Romania

Hydatid cyst is a zoonotic parasitic disease which reemerged in

the last years in Romania, with an increasing incidence of 5-6 cases per

100000 inhabitants and mortality by complications around 2%. In this

paper the authors present a case of in-hospital death of a young male

suffering of hydatid cyst. The death occurred as a consequence of septic

shock after breaking the infected vesicles. The patient was hospitalized

for 4 days, without any suspicion of hydatid cyst in this time despite the

imagistic and laboratory analyses. The autopsy revealed numerous

infected vesicles in pleural cavity and liver, the latter being the primary

site of the cyst. The case is presented in the view of literature data,

referring to the diagnosis difficulties, differential diagnosis and

complications that may result in the patient’s death.

Keywords: hydatid cyst, death, clinical diagnosis, autopsy

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CASE REPORTS OF UNUSUAL HEAD GUNSHOT

ENTRANCE WOUNDS – AN EXCEPTION OF RULES

Radnić B

a, Čurović I

b, Damjanjuk I

a, Radojevic N

b,

Mihailovic Z a

a Institute of Forensic Medicine "Milovan Milovanovic", School of

Medicine, University of Belgrade, Serbia b Department of Pathology and Forensic Medicine, Clinical Centre of

Montenegro; Faculty of Medicine, University of Montenegro,

Podgorica, Montenegro

External beveling of an entrance gunshot wound to the skull is a

known, but rare entity. We present two cases of a combined external and

internal beveling of cranial entries. In the first case, a 35-year-old

woman had two entrance wounds in the right half of the forehead, made

by a 10.2mm caliber bullet. Second case presents a 48-year-old man

with an entry wound in the middle of the occiput, made by a 7.62mm

caliber bullet. All the entry wounds on the skin had stellate appearance.

The corresponding wounds to the skull were of roughly round shape.

Both the inner and the outer plates of the bone were beveled for 2-4mm.

Bony edges of all entrance wounds were covered in soot, as a definite

sign of an entry. In this case study, we underline the importance of

recognizing this phenomenon in order to avoid misinterpretation of entry

vs. exit wounds.

Key words: entrance wound, contact wound, external beveling, gunshot,

skull

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GIANT ANEURYSM OF BASILAR SYSTEM AS

INCIDENTAL AUTOPSY FINDING

Cvetković D a, Nikolić S

a, Damjanjuk I

a, Živković V

a

a Institute of Forensic Medicine "Milovan Milovanović",

School of Medicine, University of Belgrade, Serbia

We presented two cases of giant intracranial aneurysm of basilar

artery. Such aneurisms could cause symptoms of vertebrobasilar

insufficiency or rupture. In the first case, a saccular aneurysm

(35x25x15mm) of the basilar artery was found. Up to 8mm thick

organized mural thrombus was found on the left part of aneurism.

Additionally, left vertebral artery was enlarged in form of a fusiform

aneurysm (8mm in diameter, 40mm in length), encompassing the

confluence with the right vertebral artery. Both aneurysms compressed

right side of the pons, making an impression on its ventral surface. In the

second case, a dolichoectatic atherosclerotic fusiform aneurysm,

measuring 40mm in length up to 20mm in diameter, replaced the entire

basilar artery, encompassing the left vertebral artery for another 50mm.

In both cases, the right vertebral artery was thin and without significant

pathological changes. In both cases, aneurysms were an incidental

finding, unrelated to the cause of death.

Keywords: autopsy, giant aneurysm, basilar artery, saccular, fusiform

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IATROGENIC TRACHEOARTERIAL FISTULA:

CASE REPORT AND REVIEW OF LITERATURE

Durmić T a, Čurović I

b, Bogdanović M

a, Savić S

a

a Institute of Forensic Medicine "Milovan Milovanovic", School of

Medicine, University of Belgrade, Belgrade, Serbia

b Center of pathology and forensic medicine, Clinical Center of

Montenegro, Faculty of Medicine, University of Montenegro,

Podgorica, Montenegro

Tracheo-innominate fistula is rare, but recognized life-

threatening complication most commonly associated with prolonged

endotracheal intubation.

We report the case of a 16-year-old boy who developed tracheo-

innominate fistula secondary to the prolonged intubation after a pool

accident. After 16 days of hospitalization, the patient died as a

consequence of massive haemorrhage into the tracheobronchial tree and

asphyxia.

It is a rare complication and to our knowledge no case of tracheo-

innominate fistula or any case series concerning this rare complication

has recently been reported from Serbia. This case report addresses the

epidemiology of a trachea-innominate fistulisation as a complication of

a prolonged tracheal intubation, with a special overview on the forensic

importance of it as iatrogenic injury.

Keywords: tracheo-innominate fistula, endotracheal intubation

complication, iatrogenic injury

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SESSION IV.

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THE CHALLENGE OF IDENTIFICATION

FOLLOWING THE TRAGEDY OF THE SOLAR

TEMPLE (CHEIRY/SALVAN, SWITZERLAND)

Prof. Thomas Krompecher

Institut Universitaire de Médecine Légale, Lausanne, Switzerland

On October 5, 1994, 48 members of the Sect of the Solar

Temple were found dead at two different locations in Switzerland: 23

victims in Cheiry and 25 victims in Salvan. Our Institute was

commissioned to solve the forensic problems presented by this tragedy.

Our goals were to establish the time of death, determine its causes, help

elucidate the surrounding circumstances and identify the victims. This

catastrophe was of an 'open' type: there was no list of 'passengers'; the

victims were of five different nationalities and many had just arrived in

Switzerland to participate in this event; family ties were very complex

within this group; half of the victims were burned and sometimes

charred. All the victims were positively identified within 1 month. In the

present report, we describe the steps realized to progress in our work.

The importance of being prepared for such an event is discussed.

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RADIOLOGICAL FINDINGS VERSUS MECHANISM

OF INJURY– A CASE REPORT

Tímea Maia, László Törökb, Árpád Szabó

a

aDepartment of Forensic Medicine, University of Szeged bDepartment of Traumatology, University of Szeged

We present a case of a 38-year-old Syrian refugee arrested at

the Serbian-Hungarian border, who claimed that he stumbled and fell

during running, and an immigration officer trampled on his knee. The

officer was under investigation for mistreatment in official proceedings

(Act C of 2012 on the Criminal Code). The patient was taken to the

emergency room, where he complained of a 10-day history of right knee

pain. Physical examination revealed signs of fluid accumulation and

stiffness of the right knee, without any visible skin injury. According to

his medical records, X-ray examination of the right knee showed a

horizontal fracture of the medial condyle of the tibia. These findings

were inconsistent with the alleged mechanism of the injury, therefore we

re-evaluated the original images, involving a traumatologist consultant.

The formerly described horizontal fracture turned out to be an old stress

fracture, probably due to prolonged walking. Furthermore, we

discovered a recent avulsion fracture of the tibia, which explains the

symptoms and indicates that the mechanism of the injury was indirect.

Consequently, the assault could not be proved. The reported case

highlights the importance of re-evaluating radiologic images in case of

conflicting data.

Keywords: refugee, stress fracture, avulsion fracture, forensic radiology

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SESSION V.

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THE FUNCTIONING OF THE BODY OF

FORENSIC EXPERTS OF THE SCIENTIFIC

HEALTH COMMITTEE AND THE EXPERIENCES

OF THE RECENT YEARS

Prof. Tibor Varga MD, PhD

Department of Forensic Medicine, University of Szeged

The structure and the functioning of the Scientific Health

Committee was markedly transformed by the Act No. 47 of 2005 on

forensic experts and the recently adopted Act No. 29 of 2016 left it

unchanged.

Formally, the Body does not issue a higher level of opinion,

though, since the Body was previously established, the Scientific Health

Committee is asked to form opinion in case of contradiction of opinions.

An uncertainty of the profession and the lack of a uniform practice in

quite a few topics is palpable. Questions, that ought to be discussed in

professional gatherings and that are to be ’examined’, are outlined.

Those, who do everyday work, can hardly understand the

functioning of the Body. The lecture gives an insight of the opinion

forming methods of the Body, of the professional handling of cases, and

of the relationship between the Body and courts, the Body and barristers.

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HEAT HEMATOMA

Rácz Kálmána

aUniversity of Debrecen, Clinical Center, Department of Forensic

Medicine, 4032 Debrecen, Nagyerdei krt. 98.

Heat hematoma is a rearly found alteration in burnt victims. It

develops when the head is exposed to intense heat. It has the appearance

of extradural hemorrhage but it is not acompanied by any signs of injury

by blunt force. The importance of artifact is that may be mistaken for a

true epidural bleed from a head injury and may mislead the forensic

pathologist and investigator into thinking that the fire was started

criminally to cover up a fatal assault. In my practice, I had two such

cases. I am going to share my experiences in my presentation

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QUEST FOR THE HOLY GRAIL OF FORENSICS:

IMMUNOHISTOCHEMICAL AGE ESTIMATION OF

INJURIES

Roland Weiczner

Department of Forensic Medicine, Faculty of Medicine,

University of Szeged, Hungary

Currently, the forensic age estimation of injuries is based on the

rule of thumb about the vitality signs, the entry sequence of reactive

cells, and the development of granulation and scar tissues. Supravitality,

artefacts or the lack of controls, nevertheless, can make the assessment

scientifically questionable, even without biases or “inter-observer

variability”.

Out of the histological archive of our Department, several cases

have been subjected to immunohistochemical stainings for specific

cellular markers (CD45, CD68, CD34), for the markers involved in

adhesion (ICAM-1, fibronectin) or in inflammatory signalling (TNFα,

TGFβ). For general orientation, all slides have been stained for

haematoxylin-eosin and Prussian blue, as well. Our main area of interest

lies under the “fibroblast-threshold” (<72 hours), especially in the initial

period of the first three hours after the inflicted injury. This preliminary

study aims to raise the question of utility of immunohistochemistry in

the age estimation of injuries with different origin.

Keywords: injuries; age estimation; immunohistochemistry

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THE ROLE OF FORENSIC HISTOPATHOLOGY IN

ROUTINE PRACTICE

Dénes Tótha

aDepartment of Forensic Medicine, Medical Faculty of Pécs University,

Pécs, Hungary

For many years forensic histopathology had been underevaluated

in the world. In the recent years there has been an increased awareness

of the importence of forensic histopathology (and the forensic

microscopy) and that kind of ’trend’ reached Hungary in 2014, since an

edict (351/2013) obligates the forensic experts to do histological

examinations in medico-legal autopsies.

There was 505 medico-legal autopsy between 01.01.2014 and

31.03.2016 in Baranya county. We present the evaluation of the forensic

histopathological and autopsy reports of from that period, focused on the

usefulness of forensic histopathology, specially cases, in which the

histological examination had new, unexpected results in connection with

the cause and/or the manner of death.

Keywords: forensic histopathology, autopsy, hungary.

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HUMAN TRAFFICKING – MIGRANT

VICTIMS

Prof. Tibor Varga MD, PhD

Department of Forensic Medicine, University of Szeged

In Austria, the authorities discovered more than 70 bodies of

migrants in a van, in August 2015. The human traffickers’ route was

across Hungary. It was supposed that most migrant victims had died

already in Hungary, before crossing the Austrian-Hungarian border.

During the examination of the case, questions arose, necessitating the

involvement of forensic experts. The lecture is on the forensic aspects of

the case and on the deductible lesson.

36

SESSION VI.

37

THE INVOLVEMENT OF EXPERTS IN

CRIMINAL PROCEEDINGS

Nagy Csaba

Central Chief Prosecution Office of Investigation

Regional Division in Szeged

A few years ago, an Austrian citizen, after multiple infringing

of the road code, run a policeman over with his Hummer. The policeman

was preparing to stop the perpetrator and died due to the suffered

injuries. The case had an echo. During the criminal investigation, quite a

few forensic opinions were necessitated. Six fields of expertise were

involved and several measures of criminal investigation were taken. The

lecture shows how the accusation is being formed and how complex is

the period of criminal procedure starting from after the bringing about of

a crime and up to the accusation by the prosecutor.

A highly important moral of the case is that a close cooperation

with the forensic experts and a proper elaboration of the procedure of

proof may lead to a quick and correct proof, markedly easing the work

done by the investigative authorities and by the prosecutor.

38

GUNSHOT WOUND “IDENTIFICATION”

(COMPLETING THE INAPPROPRIATE MEDICAL

RECORDS)

Szabó Árpáda, Szőke Zoltán

b

a Department of Forensic Medicine, University of Szeged

b (Hungarian) Network of Forensic Science Institutes (ISZKI), Szeged

On the 11th of October 2012 in Apátfalva (Csongrád County)

an Austrian citizen, who was driving home a Hummer H1 in a convoy

from an off-road trip, refused to pull over for the police. A few minutes

later he decided to stop for the two police motorcycle officers, who

joined the police car following him. However, before the identity check

ran through, he launched the car and hit the motorcycle policeman who

was heading towards him on foot. The policeman fell back on his parked

BMW R12 T motorbike. Although the ground clearance of the Hummer

H1 was 55 cm, the policeman’s chest got compressed between the car

and his motorcycle, leading to fatal injuries. A concrete drainage cover

on the roadside broke the left rear hub causing the leakage of the Central

Tire Inflation System. Thus the back tires deflated and the fleeing

vehicle got stuck on the dragged motorcycle. The injured policeman’s

partner opened fire on the car and the driver, who lunged out and was

eventually caught with the help of an eye-witness. The driver suffered

several gunshot wounds, partly while sitting in the car. Later he claimed

that his hand was shot while he was begging for his life on his knees. On

the other hand, the police officer alleged, that the accused sustained this

injury when he attacked him with a knife. The deficient and partly

controversial medical records hindered the determination of the shooting

directions. Comparing the skin pattern surrounding the excised entrance

and exit wounds with the scars and tattoos of the accused and the bullet

holes in the car, we were able to give a definite expert opinion. This

however confirmed the statement of the eye-witness who helped in his

disarming, not the aforementioned manners of the gunshot injury to the

hand.

39

AN AGGRESSIVE MAN’S DEATH SHORTLY

AFTER POLICE INTERVENTION

András Slezáka, Zoltán Szőlősib, Krisztina Danicsb, Éva Kellerb

aNetwork of Forensic Science Institutes, Institute of Forensic Medicine,

Gyorskocsi utca 25., 1027 Budapest, Hungary bSemmelweis University, Faculty of Medicine, Department of Forensic

and Insurance Medicine, Üllői út 93., 1091 Budapest, Hungary

A 41-year-old man behaved erratically at the airport and the

police was notified. Upon the appearance of police the man collapsed

and cardiopulmonary arrest was diagnosed. ALS was immediately

started with regular medications and he was taken to a hospital. Cerebral

coma was noted during the transportation. Upon arrival at the hospital

CT examination of the skull was performed which revealed severe brain

oedema without any focal lesion. In the clinical history nothing

significant was noted apart from slight frontal headache two weeks prior

hospital admission. According to the clinical symptoms (rapid onset,

high body temperature) the possibility of neuroinfection was also

considered but negative liquor findings ruled out this option. Clinical

toxicology was negative, he was under the influence of alcohol at the

time of his initial symptoms. The patient died nine days later. Forensic

postmortem examination was performed and the results are being

discussed in this presentation.

Keywords: police intervention, intoxication, infection

40

I AM POISONOUS FOR YOU!

Helga Szabó, MD – Éva Kereszty MD, PhD

aDepartment of Forensic Medicine, University of Szeged

What does poisoning mean? Poisoning means that a material on

the body surface or in the living organism leads to a disturbance of the

equilibrium of the organism, causing sickness or death. Nowadays,

almost every material might be a poison. Poisons could be used by cases

of homicide or suicide because they are lethal, discrete and not

circumstantial, though in some cases, accident can not be excluded.

In old famous criminal cases, poison was a must. Just take

cyanic and arsenic for example. Nowadays, the overdosing of

medicaments or that of alcohol lead to dozens of deaths per day.

In my lecture, besides historical background, I would like to

come up with some interesting poisoning cases, according to autopsy

records of our Institute.

41

THE ROLE OF EXTENDED PATHOLOGICAL

EXAMINATION IN SUSPECTED SUDDEN INFANT

DEATH (SIDS) CASES

Bokor J., Szolosi Z., Danics K., Keller E.

Semmelweis University, Faculty of Medicine, Department of

Forensic and Insurance Medicine, Üllői út 93., 1091 Budapest, Hungary

SIDS is still controversial and subject of various speculations.

Only a minority of suspected cases demonstrate pathological changes.

Critical evaluation of suspected cases is inevitable because some cases

represent criminal actions. It is important to investigate the scene of

death, ask the witnesses of death and collect all relevant data about the

prior pregnancy and the health issues of deceased. Last but not least,

detailed and full coroners’ post mortem examination should be

performed. SIDS is a diagnosis of exclusion therefore extended

histopathological examination cannot be set aside. The direct cause of

death cannot be established without performing histopathological,

toxicological and microbiological examinations. Our study describes a

series of consecutive cases of suspected SIDS investigated during the

last five years in the Department of Forensic and Insurance Medicine of

Semmelweis University. Extended histopathological examination alone

could provide important additional information which helped to

establish the correct pathological diagnosis in suspected SIDS cases.

Keywords: SIDS, histopathology, post-mortem

42

CONSTATS – OR WHAT CAN WE DO WITH

MEDICAL DOCUMENTS?

Péter Gergely

Institute of Forensic Medicine, University of Szeged

A forensic expert’s work is based on the received material. The

expert’s opinion is based on medical documentations prepared by

colleagues working in different fields. Understanding, interpretation and

follow up of the documentation is not easy. We see many faulty,

wrongful, substandard, contradictory documentations. In many cases, a

uniform professional contemplation and wording of the documentation

is lacking. The lecture is on these experiences of the forensic expert.

43

ROCHE DIAGNOSTIC SOLUTIONS IN FORENSIC

LABORATORIES

Apáti Sándor

Roche (Magyarország) Kft.

2040 Budaörs, Edison utca 1.

Roche (Hungary) Diagnostics division has been successfully working

together in many areas both with Hungarian healthcare and life sciences

partners through its high-quality products. With adequate and competent

IT resources and technical solutions, our products can provide quick and

reliable high-quality results that guarantee quality assurance and patient

safety. These equipment support modern diagnostics and help increasing

the security of modern targeted therapies in Oncology care at all leading

Hungarian Medical Universities, major public hospitals, molecular

laboratories and pathologies. Roche Diagnostics has a key role in

building long-term cooperation with domestic manufacturers.

Implementation of Belux voice recognition and dictation software’s

pathology module is one example that was arranged within the

framework of such cooperation.

The presentation provides a brief overview of Roche Diagnostics’

products which could be implemented in your forensic science

laboratory.

Subsequently the Belux voice recognition and dictation system is

presented, which includes a forensic module currently under

development by the Department of Forensic Medicine, at the University

of Szeged.

44

SESSION VII.

45

INJURIES CAUSED BY BITES BY DOGS AND

CATS FROM THE ASPECT OF THE VETERINARY

Gábor Kereszty

Veterinary’s Office, Sárvár

The frequency of human injuries caused by bites or scratching

necessitates a cooperation of physician and veterinary. My aim is to

examine the interdisciplinary fields of such injuries.

From epidemiological aspect, rabies is emphasized. Besides

historical and statistical data, the Hungarian system of the regulation of

animal health is also mentioned. The lecture is also on the oral

vaccination of foxes. The rabies has changed during the past decades:

today, cats are more exposed to rabies than foxes. A banal

transplantational contamination is also mentioned.

Dogs are rarely impacted by rabies. The clinical picture of teeth

changing tetanus points out the deterioration of teeth.

Some frequent and typical localisations – hand injury,

articulation – are also mentioned as of a forensic character. In case of

cardiological patients, stress situation is to be underlined. In case of

anticoagulated injured persons, a heavy blooding and the stress caused

by it are also to be mentioned. Tooth and counter-tooth phenomenon is

also discussed.

Etiologically, the defence of territory, that of food and that of

the off-springs, and also pain reactions play a main role. However,

playing, preying and reaction to extreme human actions are mostly the

cause of injuries.

46

DIFFERENTIAL DIAGNOSTIC PROBLEMS

CONCERNING A PERSON, DECEASED IN

PENITENTIARY INSTITUTE: CASE REPORT

Antal Kricskovics

Criminal Expert and Research Institute

The case report is about a 25-year-old person, imprisoned in a

Budapest penitentiary institute, who died in an unnatural way. The death

statement by the coroner and the site inspection suggest an unnatural

death.

The differential diagnostic problems: symptoms of death by

suffocation (point-like haemorrhagia, position of the body); observed

external lesion, high body temperature, which might have been caused

by hyperpirexia; the latter one suggests consumption of narcotics. The

consumption of narcotics (p-metil-4-aminorex) was verified by

extraordinary forensic dissection and toxicological examination, which,

shortly after, led to the termination of the criminal procedure.

The death by suffocation and the hyperpirexia reaction have

partly similar, partly different symptoms. This differentiation and the

background criminal investigation are presented during lecture,

emphasizing a nead for a complex investigation of death cases.

47

INJURIES OF OROFACIAL REGION IN

CHILDHOOD

Kasza Barbara

Szegedi Tudományegyetem Fogorvostudományi Kar, egyetemi hallgató

Nowadays after an injury has occurred, patients get treated but

they do not get any advice on preventing these injuries. Even the most

precise dental work cannot replace someone’s natural teeth which can

cause mental and bodily traumas. Babies, children and adolescent are

the most common age group related to this area’s injuries during

playground activities, sports or work out.

Children between age 3 and 18 spend most of their time at

school, hence getting hurt usually happens in these institutes. I

conducted a survey among Hungarian teachers to find out how much

they really know about orofacial traumas and also if they know how big

their role is related to treatment of these injuries.

Hopefully in the future we could make a course where teachers

could learn about helping injured kids. Also, using social media network

or placing posters and pamphlets in school could popularize prevention.

Keywords: injuries in childhood, orofacial injuries, orofacial traumas,

prevention

48

FORENSIC ANALYSIS OF INJURIES IN

DENTISTRY

Dr. Heltai Nóraa, b , Dr. Baráth Zoltán Ph.D.a, Dr. Kereszty

Éva Ph.D.b,

Szegedi Tudományegyetem, Fogorvostudományi Kar, Fogpótlástan

Tanszék, Szegeda, Szegedi Tudományegyetem, Általános

Orvostudományi Kar, Igazságügyi Orvostani Intézet, Szegedb

Inroduction: Analysing the dental injuries we found the documentation

and opinions being rather problematic. It needs a professional

evaluation, why the dental injury is out of focus, and how the diagnosis,

the pattern and the treatment is influenced by the new possibilities of

dentistry.

Aims: Tipization of the dental injuries, the comparison of the literature

and our own research data on the type and characteristics of the injuries,

setting a diagnostic scheme.

Method: Analysis of the expert’s reports in 2009-2013 at the University

of Szeged, Department of Forensic Medicine.

Results: In circa 7000 reports there were 20 cases, while according to

the literature dental injuries occur significantly more often.

Conclusion: There are negligebly few „dental cases” among the reports,

while there were more cases, where the trauma probably affected the

teeth being not documented. Origine of the injuries, the therapeutic

strategy and prognosis needs a higher thoughtfulness in the future.

Keywords: dental injury; injury report; compensation; expert's opinion

in dentistry

49

A PROSPECTIVE OBSERVATIONAL STUDY OF

RUGOSCOPY:

A RELIABLE, CHEAP AND ACCURATE METHOD

FOR FORENSIC IDENTIFICATION

Csilla Dézsia,b

, Nóra Heltaia, Éva Kereszty

a, Károly Szili

b,c,d

aUniversity of Szeged, Department of Forensic Medicine, Hungary 6724

Szeged Kossuth L. sgt. 40 b SOS24 LTD; Hungary 6722 Szeged Petőfi S. sgt. 39

c Szeged Strict and Medium Regime Prison,Hungary 6724 Szeged Mars

tér 13 d Mediteam Szeged ZRT, Hungary 6722 Szeged Petőfi S. sgt. 39

This prospective observational study was created to identify the

advantages and disadvantages of rugoscopy. After, a comprehensive

literature review on forensic dental or forensic odontology methods and

of course on rugoscopy, a prospective observational study was launched

to find the easiest, the cheapest, the most reliable and accurate method

of the rugal identification. At the first time, possible new and well-

known old methods were compared and the best ones were selected for

further examination. Dental-clay, salt-dough, intraoral and 2D camera

was found good enough for further examination as a result of this part

of the study. In the second part of the study a new rugal identification

algorithm (which was the extension of the Thomas-Kotze

method/classification of rugoscopy) were introduced and tested on

voluntaries. This study found many specific advantages of rugal

identification compared to the other method and measured its high

specificity and sensitivity with or without clinical background.

Keywords: rugae, rugoscopy, identification, forensic, dental

50

LAW AND ETHICAL ASPECTS OF DIFFERENT

OBSTERICS, GENETICS AND BIOCHEMICAL

METHODS DURING THE PREGNANCY Károly Szili

abc ,Csilla Dézsi

abcd, Kitti Sólya

c,d, Melinda Vanya

a,Iván

Devosae, Zoltán Kozinszky, Orsolya Sipos

a, Zsolt Z. Nagy

a, János

Szabó ce

a Mediteam Szeged ZRT

b SOS24 LTD

c MEDISONO Fetal and Adult Health Research Centre

d University of Szeged, Department of Forensic Medicine

e Pallas Athene University - Kecskemét

f Department of Obstetrics and Gynecology, Blekinge Hospital, Sweden

g University of Szeged, Department of Medical Genetics

The objective was to observe and identify the problems of the genetic,

biochemical and obstetric procedures. These methods could have a

hidden questions and conclusion, which is no clearly explained. The

methods was had two parts. after a comprehensive literature review on

these methods, a law and ethical analysis were performed. Thus, our

study deals with various methods including certain prenatal screening

and diagnostics methods which are widely know and advertised by

different private companies but not so easy to use and require advanced

background. After the detailed ethical, law, and clinical examination of

our cases and the literature, the conclusion was important from practical

and clinical aspects. In contrast with high efficient prenatal screening

procedures, the genetic screening procedures were harder to explained,

much expensive and useless in clinical conditions. However, the most

common problems were the lack of the administration, the lack of

relavant informations and consultation.

51

ISBN

978-963-306-481-8